Major milestone: Royal College releases new guidance on stopping antidepressants

Today I welcome the new patient information leaflet, entitled ‘Stopping Antidepressants’, published by the Royal College of Psychiatrists. 

The leaflet distills many years of work by researchers, campaigners and the prescribed harm community, which has jointly challenged previous understandings of antidepressant withdrawal as being a relatively benign experience for most people. 

Instead, the leaflet now follows the updated NICE guidelines in recognising that while withdrawal symptoms can be mild and relatively short-lived for some, for many others withdrawal can be severe and protracted, lasting for weeks, months or beyond. The leaflet also usefully acknowledges that we cannot predict at the outset of prescribing who will suffer more serious withdrawal, which of course implies that each person must be informed, before starting an antidepressant, of the potential for severe withdrawal. Offering such informed consent is especially important given, as the leaflets accepts, that ‘between a third and half of people’ who take antidepressants will experience withdrawal to some extent. This means antidepressant withdrawal in the UK is a widespread phenomenon given that 17% of the adult population was prescribed an antidepressant last year, even if we accept the lower and contested estimation of one third (contested, since the lower estimation is based on flawed company trials, methodologically designed, in my view, to minimise withdrawal).  

The leaflet also acknowledges that withdrawal can be confused with relapse, especially since withdrawal reactions (like increased anxiety or depression) can mirror the very experiences that led many people to accept an antidepressant prescription in the first place. The leaflet offers some useful ways in which withdrawal and relapse can be distinguished, but most importantly, it acknowledges that this is not an exact science, which in my view implies that doctors must listen to and respect their patients’ views on what they think their discontinuation experience denotes.

The leaflet also avoids suggesting that depression is caused by a chemical imbalance that antidepressants somehow correct. Instead, it more cautiously recognises that antidepressants increase levels of neurotransmitters (such as serotonin and noradrenaline), with the brain slowly adapting, over time, to these increased levels. If an antidepressant is stopped quickly, therefore, the brain will need time to adjust to its absence. This period of readjustment, it is ventured, is what drives the withdrawal reaction. The leaflet, therefore, suggests that tapering must occur very gradually, and at a pace in keeping with the person’s needs and experiences, which is something for which campaigners have been calling for a very long time. It also offers some generic tapering protocols as an initial guide.

In all, I believe this leaflet is a welcome development. And I congratulate its authors on its construction and publication. Its contents contrast strikingly with the view of withdrawal propounded by many establishment psychiatrists only two years ago.

I would like to believe that members of CEP have played a central role in facilitating this shift, through our research and germane publications,[i] our initiation of the recent Public Health England review into prescribed drug dependency and withdrawal (and our work as expert advisors on the review),[ii]our work with NICE in getting the withdrawal guidelines updated and our feedback to the College regarding the fraught issues pertaining antidepressant withdrawal more broadly. 

Last of all, while I’d like to think that CEP must take some credit for these changes, the greatest credit goes to those service users, withdrawal charities, online support forums and members of the prescribed harm community who have tirelessly and courageously campaigned on this issue for so many years. It’s their collective voice, courage and efforts that have ultimately shifted the dial on this critical issue. It is they to whom we all owe the greatest gratitude and for them that we must all continue the fight for suitable, national withdrawal support and provision.

Dr James Davies

[i] Davies, J., Read, J. (2018). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors. pii: S0306-4603(18)30834-7. doi: 10.1016/j.

Guy, A., Davies, J. & Rizq, R., (2019_ Guidance for Psychological Therapists: Enabling conversations with clients taking or withdrawing from prescribed psychiatric drugs (an all-party Parliamentary Report for Prescribed Drug Dependence publication). London: APPG PDD .

Moncrieff, J. & Stockmann, T. (2019). Introduction for therapists on how psychiatric drugs work. In: A. Guy, J. Davies, R. Rizq (Eds.) Guidance for Psychological Therapists: Enabling conversations with clients taking or withdrawing from prescribed psychiatric drugs. London: APPG for Prescribed Drug Dependence.

Davies, J. Read, J., M. P. Hengartner., Cosci, F., Fava, G., Chouinard, G., van Os, J., Nardi, A., Gøtzsche, P., Groot, P., Offidani, E., Timimi, S., Moncrieff, J., Spada, M., Guy, A. (2019) Clinical guidelines on antidepressant withdrawal urgently need updating

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2238 

Davies J, Pauli R, Montagu L (2018) Antidepressant Withdrawal: A Survey of Patients’ Experience (an APPG for PDD Report)

Guy A, Brown M, Lewis S (2018) The Patient Voice: an analysis of personal accounts of prescribed drug dependence and withdrawal submitted to petitions in Scotland and Wales (an APPG for PDD Report)

[ii] Taylor, S., Annand, F., Burkinshaw, P., Greaves, F., Kelleher, M., Knight, J., Perkins, C., Tran, A., White, M. & Marsden, J. (2019).

Dependence and withdrawal associated with some prescribed medicines: An evidence review. London: Public Health England.

27 Responses to Major milestone: Royal College releases new guidance on stopping antidepressants

  1. Geoff Hill 24/09/2020 at 9:49 am #

    I note that one of the academics referred to is Read, J.

    If this is the same Read, J who led the recent research on ECT, let’s hope the RCPsych will not dismiss it (as Consultant Psychiatrists are doing) as anti-psychiatry propaganda.

    In fact, there are implications in this for ECT too. In most cases, ECT should only be used after all other options have been tried. I believe it is impossible to try all other options in (as in one example) 17 days and the references to the effects of medication in this research supports my view.

    To avoid joint, I believe ECT should be banned – this is more ‘grist to the mill’.

    • Geoff Hill 24/09/2020 at 10:07 am #

      Last line should read, ‘To avoid doubt’

  2. kiwi 24/09/2020 at 9:58 am #

    Well better late than never i guess! So overdue!

    “…withdrawal can be severe and protracted, lasting for weeks, months or beyond.”
    They still just cant bring themselves to say it can they!!, that is the word ‘YEARS’ beyond means years!!
    Withdrawal left me a nonfunctioning human for over 6 years! And still the medical profession cant acknowledge this horrific reality. Here’s the thing, i am not alone.

    Be interesting to see what the medical profession will say about this.
    Oddly i still cant see any change coming. It will still be downplayed, you watch.

    If they really were serious pdoc clinics would be turned into withdrawal clinics. Withdrawal clinics need to be set up immediately and people taken off these poisons ,safely, and that, for so many will mean years of tapering!
    Thats right i said it YEARS of tapering. Something that is still not being acknowledged or doesnt want to be acknowledged!

    Thankyou CEP for all your efforts.

    • Barry Haslam 24/09/2020 at 6:59 pm #

      Well said Kiwi. I too thank CEP for all their efforts.

      Can i also thank George Roycroft for his involvement. I have ‘worked’ with George for a number of years in educating him, initially on the dangers of long term prescribing of benzodiazepines. He admitted that he was learning on the issues involved, not having the expertize personally but was prepared to listen and learn.

      We urgently need a national system of dedicated withdrawal centres and after care facilities for prescribed drug dependent patients. Patients who only ever took their meds ‘as prescribed’ by their doctor’s.Fully funded by the NHS and with urgent government approval. Withdrawal to be at a pace with each patient’s agreement.

      I was instrumental in obtaining a dedicated withdrawal facility here in Oldham, Lancashire in 2004 for PDD patients on long term benzodiazepines and was involved until 2018. The service is still current and is for all patients who are dependent on benzodiazepines, z drugs, antidepressants and opiate painkillers. The contract up to 2018 was awarded to the Charity, Addiction Dependency Solutions and from that date to Turning Point.

      We in this country have never had the political will to take on the vested interests and have been very badly let down by successive governments. This needs to change and change quickly, especially with the large upsurge of SSRI prescribing due to the CV19 virus epidemic, creating even more prescribed drug dependency and future suffering for those caught in this cruel trap which can take years to exit.

      • Geoff Hill 24/09/2020 at 11:23 pm #

        Barry – With respect, we should not need specialist withdrawal clinics.

        What we need is ALL GPs and psychiatrists to be trained in weaning patients off potentially addictive medication.

        In fact, reasonably competent GPs and psychiatrists have known for years about the importance of ‘tapering’ off medication and have acted accordingly. Please also see my reply to Sarah.

        This might be unpopular but the opening of withdrawal clinics is only throwing more taxpayers’ money at the problem is addressing the symptoms, not the cause. The real problem is the NHS’s failure to ensure that all its NHS GPs and psychiatrists are adequately trained.

        It must be said that this is by no means the only example of NHS spending more money to remedy self-inflicted failings! It is why many commentators (and increasingly the public) believe the NHS does not need more taxpayers’ money: simply, it does not use its existing funding in accordance with Total Quality Management principles.

        • kiwi 25/09/2020 at 4:56 am #

          “In fact, reasonably competent GPs and psychiatrists have known for years about the importance of ‘tapering’ off medication and have acted accordingly.”

          Geoff thankyou for your post. You are clearly very knowledgeable on this topic.
          I however see this from a different angle and from my own experience and the experience of thousands of others have found it to be quite the contrary. The medical profession have shown a complete vacuum of knowledge when it comes to ‘tapering’ and ‘acting accordingly.’

          When it comes to suggesting that ‘doctors have known for years’ i don’t know so much.

          Why only today in the paper i read this
          https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12367564

          This comes as no surprise to me. It was only a year ago a local parent told me their teenage child had been diagnosed ADHD. I asked how did this diagnosis come about? The reply horrified me. A mental health worker had come to the school and talked about the symptoms of ADHD after which their child came home and suggested to the parents they felt they were ADHD. So off they went to a psychiatrist and as it is so often found to be true, if you believe you have something you will have no trouble finding a doctor who will agree with you. The result is that that child has now been on ritalin for over a year.

          What the medical profession have been doing and are continuing to do is truly frightening.

          One thing seems to be very clear to me, things are getting worse not better.

          • Geoff Hill 25/09/2020 at 10:17 am #

            Kiwi – I know from personal experience that competent Consultants have been aware of the importance of tapering since 1984! However, I’ve had the benefit of a private provider – through medical insurance not wealth!

            Perhaps my comment about GPs was insufficiently clear. Private Consultants are far more robust in ensuring that patients’ GPs follow their (the Consultants) guidance on dosages. I should have written that reasonably competent GPs always follow Consultants’ guidance – this applies to all medical treatment not just to psychiatry.

  3. Nicola 24/09/2020 at 8:47 pm #

    So pleased to see this today 14 months of horrendous withdrawals with zero help from my gp and still suffering let’s hope things continue to change for the better … prescribed an antidepressant for pain without any information given , well this can’t happen anymore so it’s bitter sweet .
    But I thank every single person who’s fought for this .

    • Geoff Hill 24/09/2020 at 10:55 pm #

      Nicola – so sorry to hear of your suffering – it was completely avoidable even before the Royal College amended its guideline.

      Your GP should have known better. Although I cannot advise without more information, I believe you might have grounds to complain or even litigate. Your suffering was unnecessary.

      Reasonably competent GPs and psychiatrists have known of the tapering effect for donkeys’ years. Please see my reply to Sarah’s comment on this blog and feel free to contact me via my own blog: https://999crash.wordpress.com/blog/

  4. Sarah 24/09/2020 at 9:00 pm #

    Thank you for sharing this leaflet. I wish I was given this information when I was prescribed Paroxetene, which I took for 12 years, with this my third year of withdrawal. I would not have taken this drug had I known what could happen when I stopped. I just hope the tapering messages are communicated thoroughly to general practitioners, not just in the UK, but around the world. I have shared the link in an SSRI withdrawal group as it brings a message of hope that patient suffering is finally being heard and acknowledged.

    • Geoff Hill 24/09/2020 at 10:45 pm #

      Good news indeed.

      However there is a hidden implication relating to ECT. Even under current guidance (save for very limited exceptions) ECT should only be used as a last resort. I interpret this as meaning that two different anti-depressant drugs (as well as talking therapies) must be tried before ECT is considered.

      It is well-known that a second psychiatric drug should not be given for at least 7 days after the first to allow the body to be cleansed of the first drug, i.e. the tapering effect. I have an example of ECT being used within 17 days of admission – I do not accept that it is possible to try two different drugs and talking therapies in 17 days.

      Sarah – I’m sorry you stopped Paroxetene suddenly after 12 years. You were ill-advised. A reasonably competent GP or psychiatrist would have told you not to do so.

      Even notorious Valium (Diazepam) can be tapered off gradually in a couple of months without withdrawal symptoms. At 2mg, it has no more than a placebo effect.

  5. chris 25/09/2020 at 9:41 am #

    Sorry but a leaflet isn’t a mile stone. Enormous amounts of lives have been ruined world wide due to this horrendous harming fraud. When people, survivors of psychiatry/GP’s get decent compensation that will be a milestone. Only wealthy people who have the mental strength can sue the vast majority can not. A mile stone is financial compensation. As I type this I experience both significant pain/numbness in my hand/fingers from akathisia – I slashed my wrist deeply. We want significant compensation.

    • Geoff Hill 25/09/2020 at 10:04 am #

      Chris – I agree that there is no legal remedy for those who cannot afford the cost of litigating (and don’t forget the risk of costs being awarded against them of they lose).

      I suspect this is why, in my experience, private Consultants, who, by definition, are dealing with wealthy or insured patients, are far more cautious. An insured patient may not be wealthy but h/she probably has legal expenses insurance too!

      I know too that private Consultants are more robust in ensuring that patients’ GPs follow their guidance.

      This also proves that the threat of compensation works – and would do so in the NHS too if such a remedy was available to less well-off patients.

  6. chris 25/09/2020 at 10:56 am #

    I can just see it getting mind blowingly worse. There will be screening for post covid PTSD The two drugs UK licensed for PTSD are Sertraline and Paxil – just about the worst for akathisia. Plus AD’s for pain and even migraine. Horrific future.

    • Geoff Hill 25/09/2020 at 11:30 am #

      Chris – just for balance, I’ve never experienced akathisia resulting from Sertraline.

      Again, I suspect – just like knowledge of tapering, it relates to the competence of the prescribing clinician.

      Personally, I believe campaigning against barbaric ECT is of equal importance. That is my current priority – I do not have personal experience but I know two carers of patients who have been ‘treated’ with Electroconvulsive Trauma (as I prefer to call it) with life-changing consequences for carer and patient alike.

  7. chris 25/09/2020 at 3:18 pm #

    Take a look at David Healy re Sertraline.

    ‘barbaric ECT is of equal importance’ No doubt

    There is a vaccine damage payment so why not these vile toxic psych drugs

    https://www.gov.uk/vaccine-damage-payment/eligibility

    “influenza, except for influenza caused by a pandemic influenza virus” interesting wonder if that will include covid nodoubt they will change it soon.

    “This could be a mental or physical disablement and will be based on medical evidence from the doctors or hospitals involved in your treatment.”

    So much for trashing the autism link – there it is ‘mental disablement’ as a result of vaccines on the gov website.

  8. Pauline Thomas 25/09/2020 at 9:20 pm #

    I would hope that most people who go to their GP or hospital psychiatrist seeking help would have autonomy to refuse or disagree with the treatment they were offered. I hope they would be able to say ‘I do not like this drug’ I hope they would be listened to. Unfortunately this is not the case if you have a learning disability.

    My son has a learning disability. He cannot always tell me accurately how the drugs he is being prescribed are affecting him. I monitor his reactions to his medications. I know however when they are not right. However my opinions and concerns are not listened to when we go to see his NHS psychiatrist because my son is over18 years old. In fact he is 48 years old! Long enough for me to know him so well. How can this be fair and right when a parent can be dismissed so readily because their son/daughter is deemed to lack capacity.

    I thank CEP for all that they have done and achieved through their tenacity and belief in what is right. Lets hope that all psychiatrists take this on board. Withdrawal is real and painful and horrific. My son”s withdrawal from Lamotrigine and Tegretol have been so horrendous. Six painful years, but there is a light at the end of the tunnel but unfortunately my ongoing disagreements with his psychiatrist has taken its toll on me.

    • Geoff Hill 25/09/2020 at 11:42 pm #

      So sorry to learn of your experience Pauline. The son of one of my peers (Dr Sarah Ryan – an academic doctor, not a medic) had learning difficulties. His death was deemed preventable owing to the negligence of an NHS Consultant Psychiatrist. As a result, the Trust gained a criminal conviction with a fine of £1.05 million and the Psychiatrist was sanctioned by a disciplinary tribunal.

      On the same day, the Trust was sentenced for a second criminal conviction for a preventable death, which it failed to self-disclose to the Health & Safety Executive. I reported it, resulting in a second criminal conviction and a fine of £0.95 million, sentenced on the same day [R v Southern Health NHS Foundation Trust, sentencing remarks by Mr Justice Stuart-Smith In the Crown Court Oxford on 26 March 2018.]

      In sentencing, Mr Justice Stuart-Smith made allowance for the fact that taxpayers’ were effectively paying the fine. The maximum tariff is a fine of £10m per offence, i.e. on this occasion £20m in total, so some would argue that the trust ‘got off’ lightly.

      Unfortunately, I was too unwell with what, I suspect you ladies call, man-flu, to attend the sentencing hearing. I understand that the public gallery was packed to capacity.

      This was achieved only by the persistence of Dr Ryan and me over a pro-longed period of time. You should be prepared to be treated with open hostility by the provider concerned. However, your son is still alive so you may wish to consider carefully the potential impact of such action on his future care.

      I hope this helps. If you feel I can be of further assistance, you can contact me direct via the contact page of my blog.

      • chris 26/09/2020 at 9:10 am #

        That is excellent – yourself and Dr Ryan – made of strong stuff. So many people do not have that ability to go up against what is happening. I read that trusts now have to make public the deaths of people in their care every quarter.

        • Geoff Hill 26/09/2020 at 12:04 pm #

          Chris – ‘ability’ is not key: it’s dogged determination and familiarity with Mr Google.

          May I suggest three books to read: they give you both sides of the story from the viewpoint of carers and mental health nurses alike. They are competitively priced.

          1. ‘Justice for Laughing Boy’ by Dr Sara Ryan (forward by Baroness Helena Kennedy QC): available from Amazon and, by order, all good book shops.

          2. ‘The Busy, the Bossy and the Bully’ by Lucy la Zouche (a penname) a searing exposé of bullying in the NHS; the inability of NHS mental health trusts to support staff members; and the impotence of the Nursing & Midwifery Council. It incorporates ‘The NHS, the Uniform & the Blackberry®‘ the true story of a mental health nurse trainer, a victim of bullying and mobbing, driven to attempt suicide.

          3. ‘The NMC Survival Guide’ by Lucy la Zouche – a guide to how one health regulator treats its members.

          ‘Lucy’s’ two books are available though ‘her’ website, https://lucylazouche.com/my-books, which links to Amazon. ‘Her’ book on the Beaumont family has links to another fellow campaigner (now deceased) – John Beaumont – a Public Governor of the same NHS Trust, who resigned his position on realising its true culture.

          The nurse was fortunate in having as father-in-law, the retired CEO of a multi-national company – who I also know. HE is Lucy and you can guess the Trust’s name! This is another nurse lost to the NHS for good: now pursuing another career away from the health & social care sector and thoroughly enjoying it. Without ‘Lucy’ as father-in-law, he might have been lost to the world.

          And finally, my favourite book on leadership – ‘The Military Leader’ by serving US army officer Andrew Steadman – for purchase only by those with an interest in leadership. For everyone else, I can quote two brief passages I believe are especially relevant to the NHS (and not limited to mental health services).

          1. Under ‘Systems that Strangle‘:

          “Teams and their members take fewer risks and stop fighting for new insight when they have processes to protect them. It’s not intentional, it’s a function of our innate propensity to seek homeostasis…a comfortable, predictable environment.”

          Identical to some of the problems in the NHS?

          2. Under, ‘Three Traits That Will Get You Fired’:

          “How do you identify the bad apples, the ones who will have a corrosive or even dangerous effect on your unit or another unit down the road? What subordinate traits are unacceptable and worthy of dismissal?”

          “Lack of integrity. Integrity is a clear line in the sand, especially as rank increases. Integrity is so common among our community that we often assume it is a default trait for all service members and fail to assess or teach it enough. Leaders must aggressively investigate any hint of integrity violations, as they are not problems that will fix themselves.”

          I believe identical comments apply to the NHS community – it is assumed that integrity is a default setting – trouble it is not, especially at senior leadership level, and when it is identified no-one gets fired!

          How about Lord Sugar (for a limited period) to replace Sir Simon Stevens when he steps down as CEO of NHS England. He would soon identify the bad apples and point the finger – “YOU’RE FIRED”. In the BBC documentary ‘Broken Trust’ another ex-governor likened the CEO of the Trust to an Alan Sugar apprentice!

          Michael O’Leary of Ryanair would be a suitable candidate too with his expertise in lean management! I resist the temptation to suggest ‘the Donald’ [Trump] if he loses the upcoming US Election to “Sleepy Joe Biden”!

    • chris 26/09/2020 at 9:33 am #

      “However my opinions and concerns are not listened to when we go to see his NHS psychiatrist because my son is over18 years old. In fact he is 48 years old! Long enough for me to know him so well. How can this be fair and right when a parent can be dismissed so readily because their son/daughter is deemed to lack capacity.

      I thank CEP for all that they have done and achieved through their tenacity and belief in what is right. Lets hope that all psychiatrists take this on board. Withdrawal is real and painful and horrific.”

      Pauline, psychiatry has a horiffic – and until recently – hidden history. It’s best to try to get away from it and if possible stay away from it. I know that is not really possible in your situation. It should have been abolished and outlawed for major crimes against humanity after WWII. It didn’t happen because a psychiatrist – Leo Alexander was lead investigator of the doctors trial at Neuremberg. According to Breggin he was a eugenicist and supporter of ECT and insulin ‘therapy’. If the full facts had of been brought to light Ernst Rudin and very many psychiatrists would have hung. Almost all of the German psychiatrists sterilized and murdered their patients pre during and post WWII. It has only been in recent years that all of this has come to light. Breggin was on to it early:

      http://breggin.com/wp-content/uploads/2008/01/psychiatrysrole.pbreggin.1993.pdf

      • Geoff Hill 26/09/2020 at 4:38 pm #

        I have a response to your comment, which is awaiting moderation. It included a gentle suggestion about Godwin’s Law, which I suspect you have already breached.

        Perhaps my response is awaiting moderation because it was more specific in the names associated with Godwin’s Law so, in itself, breached Godwin’s Law.

        To avoid any risk of a repeat offence, please see: https://en.wikipedia.org/wiki/Godwin%27s_law.

        You will find that it is not a statutory law but, with the benefit of hindsight, it makes sense. I only learned of the Law two weeks ago when I had a comment pulled from Health Service Journal.

        • chris 26/09/2020 at 5:17 pm #

          It’s specific to psychiatry rather than Nazism. As Fredric Wertham states:

          “The tragedy is that the psychiatrists did not have to have an order. They acted on their own. They were not carrying out a death sentence pronounced by some one else.”

          I’ve spent months inside psychs closed cultures of abuse and have first hand witness to the depavity and abuse to make the correlation to what happened from the 1930’s on. This is happening because of high dose polypharmacy causing akathisia/toxic psychosis/suicide/violence – plus much more – and being met with even more abuse. It has to be exposed and stopped, very much part of achieving that is to know the important history of psychiatry. Many people do not they think it’s there to help people, it’s not.

          • Geoff Hill 27/09/2020 at 12:30 pm #

            Chris – third para. of previous message should read DOH – Dept. of Health. However, I have just seen that my previous comment is ‘awaiting moderation’. Haven’t broken Godwin’s Law time but am wondering if (like other forums) it has been referred for moderation because it includes more than one hyperlink. We’ll see.

  9. Pauline Thomas 26/09/2020 at 3:09 pm #

    Chris and Geoff, thank you both for your kind words. So welcome when I feel that I am standing alone against a bullying psychiatrist.

    I too admire Dr.Sara Ryan. I have her book ‘Justice for Laughing Boy; and I have ordered her latest book ‘Love, Learning Disability and pockets of Brilliance’. She is a heroine.

    Two more books that have opened my eyes to the psychiatric world are Peter Breggin”s ‘Psychiatric Drug Withdrawal’ and Joanna Moncrieff’s The Bitterest Pills’. Both have been invaluable in understanding how drugs can harm as well as heal.

    Another woman who has pioneered a change in the way the NHS medicates people who have a learning disability or autism is Paula Mcgowan. Her son died in hospital after being given a drug which she said her son could not tolerate. The doctor overruled her. Shocking. There is now a directive from NHS England that states that doctors should ASK people with LD,autism or both their families and carers their opinions and concerns about treatment.LISTEN to all involved and show respect to those opinions and concerns and DO something about it and work in partnership with us. The ASK, LISTEN DO directive should also apply in my opinion to everybody who is battling a mental illness whether they have a learning disability or not. None of us should look down on anyone unless we are helping them up.

    • Geoff Hill 26/09/2020 at 4:25 pm #

      Pauline – you are welcome to and thoroughly deserving of kind words.

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